Effect of tension induced by Shouldice repair on postoperative course and long-term outcome.

Objective: To record intraoperative tension during Shouldice hernioplasty and correlate it with postoperative course and long-term outcome.

Design: Prospective clinical trial.

Setting: University clinic, Germany.

Subjects: 20 male patients undergoing elective primary inguinal hernia repair by Shouldice technique.

Intervention: Measurement of intraoperative tension during hernioplasty (low 0-2.0 N, moderate 2.1-4.0 N, high > 4.1 N).

Main Outcome Measures: Postoperative pain measured by visual analogue scale (VAS) at rest and activity, pain-related change of ventilatory measurements (8, 24 and 48 hours after intervention), postoperative complications, length of stay in hospital, and recurrence rate at mean 46.7 (range 43-54) months after operation. Data are given as mean (SD).

Results: The results for 18 patients were analysed, 2 being lost to follow up. Mean pain score was 17.5 (15.6), 14.8 (15.6) and 12.3 (14.9) at rest 8 hours, 24 hours and 48 hours after operation, during activity 42.0 (16.5), 36.4 (18.5) and 33.7 (19.1) respectively. Most depression of ventilatory measurements was found 8 hours after operation (vital capacity 88.4 (12.5)%. peak flow 81.3 (17.2)%) compared with preoperative values. Complications comprised one seroma, one subcutaneous wound infection, and 3 haematomas. Mean length of stay in hospital was 4.3 (range 2-7) days. At follow up, no recurrences were found. No correlation with intraoperatively-induced tension was found.

Conclusions: Postoperative pain and recurrences depend on many factors, but induced intraoperative tension can be excluded. The reported advantages of tension-free procedures are not based on the avoidance of tension. The Shouldice repair can therefore continued to be used as a routine technique in uncomplicated primary inguinal hernia repair.